A question with a number in it

Review and sources

Not clinically reviewed. No clinician has signed this scenario.

• Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469-472. 343 doctors provided survival estimates for 468 terminally ill patients at hospice referral; median survival 24 days; only 20% of predictions accurate to within 33% of actual survival, 63% over-optimistic, 17% over-pessimistic; survival overestimated by a factor of 5.3. As the duration of the doctor-patient relationship increased and time since last contact decreased, prognostic accuracy decreased.
• Weeks JC, Catalano PJ, Cronin A, et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012;367(17):1616-1625. 69% of patients with lung cancer and 81% with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. Patients who rated communication with their physician most favourably were more likely to hold inaccurate beliefs (odds ratio highest versus lowest third 1.90, 95% CI 1.33-2.72).
• Kiely BE, Martin AJ, Tattersall MHN, et al. The median informs the message: accuracy of individualized scenarios for survival time based on oncologists’ estimates. J Clin Oncol. 2013;31(28):3565-3571. 21 oncologists estimated survival for 114 patients with advanced cancer; median survival 11 months. Observed survival was between half and double the estimate in 63%, a quarter of it or less in 6%, and three times it or more in 14%. Estimates were imprecise: 29% fell within 0.67 to 1.33 times observed survival.